February 2, 2011, 11:47 am

I Believe This is Killing Me

It didn’t take long for Doctor Throwafit to realize he had some ‘splainin’ to do.

You don’t tug on Superman’s cape,

You don’t spit into the wind…

And you don’t ever, EVER mess with the nurses in the emergency department!



Oh my god. I need a long vacation.

I am sitting here in Starbucks for the first time in months – I can’t even remember the last time I blogged over coffee – and their microwave kept alarming. I got out of my chair to go check the alarm!

Yeah, my nerves are on edge. They are playing this finger-snapping Vegas-jazz stuff over the speakers that has me buzzing like my finger is in a socket. Hey, guys, what does a girl gotta do for a little Motown ’round these parts?


Ah, but there is a silver lining on the horizon!

I am looking forward to attending the ENA Leadership Conference in Portland, Oregon in just a couple of weeks, which I will cover here at Emergiblog. The link will take you to the live blog for the event.

The ENA always puts on stunning programs – literally “attend today, use in practice tomorrow” information. You don’t have to be a manager to attend the Leadership Conference, either. All nurses are leaders, and there is more than enough in this conference for every nurse, from newbie to veteran.


The department is chaotic.

Every bed full.

The hallways are impacted.

With patients. Family members. Lab techs. Portable xray machines and those who wield them.

Three ambulances waiting to give report.


What the hell do they want?

Doctors. Hospitalists. Cardiologists. Intensivists. A rare primary physician who admits their own patients.


Who want everything….STAT.

Even though nothing about their patients require STAT.

Somewhere in there is the ER physician. And the PA.

We’re on divert, except no one told the three ambulances.


No place to sit.

No place to chart.

No place to stand.


And in the middle of all this…

In the middle of this bedlam.

Comes the order.

To give the first dose all the prescribed medications to the ambulatory, playing, giggling child with otitis media, who is with a totally ambulatory, fully functional, totally-capable-of-going-to-the-pharmacy-and-starting-the-medication-at-home adult parent.

So what, you say?

Well, this means that instead of being able to discharge this ambulatory, capable parent with discharge instructions and a prescription right then and there, the RN must now engage in the preparation and administration of a pediatric medication.

Which means:

  • Going to the Pyxis and removing the medications, say Tylenol and Zithromax, from the machine.
  • Because the Hilton Hospital has no Pharmacy at night, the Zithromax must be reconstituted by the RN – yep, we measure it, we mix it, we shake it, we pour it.
  • Calculating the appropriate dose based on the child’s weight (yes, we have to do that, even if the doctor has written a dose).
  • Pour the meds, draw them up into a dosing syringe.

No biggie so far? Remember all the hell going on in the rest of the department? One nurse is tied up doing this totally unnecessary function. But it gets better because…

They have decided that decades of nursing experience is not enough to ensure appropriate safeguards in pediatric medication administration so…

  • A second nurse has to calculate and double check everything the first nurse has done and sign off on the calculations before the medication is given.

And there you have it! Two nurses taken from much more critical work to make sure ambulatory, playing, giggling child with otitis media gets their first dose of medication, when there is no reason on God’s green earth Mommy and Daddy cannot go get the medication and start it themselves.

And why?

Because it all has to do with patient satisfaction!

If we don’t do this, they don’t think we treated their child. And gosh, it’s the middle of the night and who wants to wait with a tired kid at the pharmacy and what if the pharmacist is on break and what if they don’t have the cash and what if the ATM machine is broken and…..


Seriously, people, this is the minutiae that we have to deal with.

I want to take good care of my patients, I really do. I like my patients, I want to make their stay in the ER easier and more comfortable and as pain free as I can possibly make it.

I’m a good nurse. No. I’m a damn, excellent nurse.

But this bullshit is killing me.

Killing me.

Oh, and someday, let’s go out and have a drink and I’ll tell you about the time I got the order to irrigate my patient’s ears. In fact, it was on the same night. She was having a bit of trouble hearing, you see. Berated me because I wasn’t doing it fast enough. She didn’t care that hypotension and a cath lab patient trumped ear wax.

Yeah, I definitely need a margarita to tell that one…..


  • deedoyle

    February 4, 2011 at 3:33 am

    The trials of the ER nurse, and any urgent care nurse are many. My sympathy and empathy to those who trudge daily through the maze to give the best possible patient care possible.
    Dr. Pamela Wible speaks on community-based patient-centered care at the One Path Summit in Atlanta this March 26-27. Along with 7 of her peers, Dr. Wible will join in discussions on traditional and complementary medical practices.
    For more info go to http://www.onepathsummit.com.

  • John

    February 4, 2011 at 4:57 am

    Oh , My sympathy is with you. Don’t feel low. I’m sure you will get something to learn from such kind of experiences too

  • TD

    February 4, 2011 at 3:23 pm

    As an ER doc, I totally share your frustration. Our job is not to make patients happy. Our job is to make them better.

    If they wind up happy because we’ve made them better, then that is great. However, patient satisfaction is not my goal. My goal is to provide good care.

    Unfortunately, patient satisfaction is becoming more and more of a forced issue. Many ER groups are starting to use patient satisfaction ratings as a factor in determining the physicians’ pay.

    Talk about a conflict of interests!


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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